Alcohol Pros and Cons for Health and Training

Alcohol Pros and Cons: Finding Moderation for Health and Nutrition

By: Jeremy Partl, Registered Dietitian

When we learn about basic nutrition, we commonly focus on the three most frequently consumed macronutrients—protein, fats, and carbohydrates. However, there is a commonly neglected macronutrient that doesn’t get a lot of attention despite how popular it is in our society: alcohol.

When Homer Simpson called alcohol “The cause of…and solution to…all of life’s problems,” he wasn’t wrong about how much alcohol consumption is a part of society. Alcohol use is part of many cultural, religious, and spiritual practices. Nearly 70% of those above the age of 18 years in most industrialized countries drink alcohol, with the majority coming from the Americas, Europe, and the Western Pacific.^[1],^[2]

In this article, I will cover commonly asked questions and topics related to alcohol intake and health, body composition, and performance.

An Apéritif

To understand why alcohol affects us the way it does, we should look at how it is processed in the body.

Unlike the other macronutrients, alcohol (technically known as ethanol) contains seven calories per gram, making it nearly twice as energy-dense as protein and carbohydrates (at four calories per gram) and slightly less than fats (at nine calories per gram). Unlike other macronutrients, ethanol lacks nutrients and is often referred to as “empty calories.”

Alcohol is readily absorbed throughout the entire gastrointestinal (GI) tract, and the rate at which it is absorbed is likely affected the most by the presence or absence of food in the stomach (a fuller stomach slows the rate of absorption), the carbonation of the drink (champagne is absorbed more quickly than non-sparkling drinks), and the concentration of alcohol (higher alcohol drinks are absorbed faster).^[3],^[4]

Once it makes its way through the GI tract, it heads to the liver, which metabolizes upwards of 90% of it. While it’s not above the scope of this article, the basics of alcohol metabolism are as follows:

Alcohol is broken down by the enzyme alcohol dehydrogenase (ADH) -> ADH then metabolizes the alcohol into acetaldehyde -> Acetaldehyde is broken down into acetate by another enzyme, aldehyde dehydrogenase -> Acetate is further metabolized and excreted as waste products carbon dioxide and water.

This is a slow process, with the oxidation of ethanol happening at around ~15 grams per hour (equal to one regular beer), which is why it is pretty easy to overload the system and get drunk.

Furthermore, the liver prefers ethanol for fuel so much that it will displace other substrates when available. In other words, it will use the alcohol first and store the carbohydrates and fats that you are eating in glycogen and adipose tissue.^[5]

The Downsides of Alcohol Intake

You don’t have to look too far to find well-publicized risks of drinking too much alcohol. What are some of the more common negative health consequences of excessive alcohol consumption? ^[6]

• Liver diseases, including cirrhosis and liver failure
• A higher risk of high blood pressure, heart failure, and dementia
• A higher risk of certain cancers, including those of the GI tract (including colon cancer), breast, and liver
• A higher risk of injury, especially from drunk driving and falls
• Rising numbers of homicides and suicides that are also often alcohol-related
• Poor judgment that may increase the likelihood of engaging in risky sexual behavior, addictive behaviors, and/or use of drugs and substances
• A higher risk of depression, anxiety, and addiction which may, in turn, affect one’s ability to establish and maintain social relationships and employment
• Alcohol poisoning
• Fetal alcohol syndrome that can damage a baby’s developing brain and cause other developmental abnormalities
• Chronic and heavy alcohol intake has been observed to increase the risk of osteoporosis and bone fractures through reduced bone density. Furthermore, bone repair and remodeling are also impaired with high alcohol intake. ^[7],^[8]
• Heavy alcohol consumption diminishes the uptake and utilization of folate, vitamin B6, vitamin B1, vitamin K, and vitamin A.^[9]

The vast array of negative consequences on overall health is a long laundry list for anyone in the general population. But I want to focus on a couple of even more relevant ones to the strength training population.

• Protein Synthesis—Studies show that both acute and chronic alcohol ingestion can have a detrimental effect on cell signaling and protein synthesis in skeletal muscle. In other words, you may be risking the hard-work that you are doing in the gym by drinking alcohol.^[10]
• Reduced Inhibitions—Alcohol changes the brain chemistry, which in turn impacts moods, behaviors, thinking, memory, and physical movement and bodily functions, which may have costly side effects. Many of us have tales of doing stupid things and making poor choices when we consume alcohol. If we are not careful, these poor decisions can be dangerous to our waistline (among other things). How much easier is it to say yes to the high-calorie appetizers and desserts at a party when you have had a drink or two?
• Recovery and Sleep—As I mentioned in this previous article, on the outside, alcohol seems like a helpful substance to get you to sleep. While that may be true, it actually decreases overall sleep quality. The downstream effects of reduced sleep include poorer decision making, higher hunger levels, worsening performance, and more, over time, impacting the physical results that you want from training.

What About Benefits?

I’m sure you’ve heard before that there are benefits of “drinking in moderation.” For those who are into using popular examples, they may say that “the longest living populations in the Blue Zone areas of the world drink alcohol, so why is it looked down upon?” Furthermore, it may even underpin the “French paradox”—a low incidence of coronary artery disease attributed to drinking wine despite high levels of dietary cholesterol.

What does the research have to say? I think it goes along quite well with those above lines of thinking.

• From a 2020 paper on the topic of cardiovascular disease (CVD): “The relationship between alcohol consumption and CVD appears in general terms biphasic, being protective at low and moderate amounts and detrimental at high intakes, even when occasionally consumed.” “It would be wise to suggest low–moderate alcohol consumption among current drinkers and never recommending drinking in order to improve health outcomes.”^[11]
• Alcohol may help to control cholesterol levels, raising the “good” HDL sub-particles.^[12],^[13]
• Light to moderate alcohol consumption is generally reported to be beneficial, resulting in higher bone mineral density (BMD) and reduced age-related bone loss and remodeling.^[14],^[15]
• Light to moderate alcohol intake may lower the risk of diabetes and gallstones.^[16]

What’s hard to measure in the research is all of the other variables of health—like diet quality, lifestyle habits, etc.—that probably play a bigger role. Take two people who drink the same amount of alcohol—one with a pristine lifestyle, and the other eating processed foods, having high stress levels, and sleeping poorly, etc.—and you will likely have two completely different outcomes.

Remember that, with research, correlation does not mean causation.

As I wrap up this section, it would be wrong to neglect one of the most relevant reasons people drink—the social component of alcohol intake. Whether it’s drinking a glass of wine when you are out to dinner, drinking a beer with friends while watching football, or wrapping up the week with a celebratory shot with your spouse, alcohol is something that brings us together.

Calorie and Nutrient Content of Popular Alcohol Drinks

Many beverages contain a wide variety of different alcohol contents, expressed as the percentage of alcohol in any given drink. The following percentages are usually contained in each standard drink—five ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof (40% alcohol) distilled liquor.^[17]

• Beer: 5% alcohol
• Wine: 12% alcohol
• 100 proof liquor: 50% alcohol
• 80 proof liquor: 40% alcohol

If you’re looking for specific nutrition information, I suggest checking out this comprehensive list here.

Generally speaking, the total caloric content of various alcoholic drinks varies based on the amount of alcohol, the total volume of a beverage, and the number of carbohydrates and sugars and mixers put into the drink.

So, are there better choices when it comes to drinks than others?

Some of your lowest-calorie bets^[18]:

• A shot of spirits (a 1.5-ounce shot of vodka, gin, rum, whiskey, or tequila contains an average of 97 calories)
• A glass of champagne (about 84 calories per four ounces)
• A glass of dry wine (approximately 120 to 125 calories per five ounces)
• A traditional martini (an average of 124 calories for a 2.5-ounce serving)
• A light beer (approximately 100 calories)
• A glass of reduced-calorie wine (about 90 to 100 calories) is another lower-calorie option.

There are a large number of lower-calorie options on the market now that make it easier to be conscious of both being able to socially have fun as well as be mindful of your body composition goals.

The main issues arise when we add mixers (tonic water, juice, soda, syrups, cream, and coconut), when we greatly exceed portion sizes, and/or when we imbibe multiple drinks over the course of a few hours. What becomes a relatively low-calorie drink becomes a meal-sized caloric punch with negligible amounts of nutrients.

It can be hard to give concrete recommendations because people’s preference for alcohol differs widely and is based on what we like rather than what may be the most optimal drink. It’s good to have awareness because it does provide some sort of basis for improving drink selections by lowering the overall caloric content of the drink.

What are some other things to consider, and some general recommendations?

• Consider alternating drinking water between (or alongside) alcoholic drinks. This may help to prevent over-consumption by increasing fullness without additional calories.
• Drinking alcohol with a higher percentage and lower caloric value (like wine) may mean a total overall lower-calorie consumption if less is consumed.
• Liqueurs can be quite deceptive and tasty, but they also are calorie bombs. Thus, it’s probably best to avoid or very greatly limit them.
• If you are going to drink and eat, it’s important to have healthy options available. Because of relaxed inhibitions, having high-calorie foods around and available is risky territory for further compromising nutritional habits.

How to Further Quantify the Nutrition in Alcohol

If you are someone who counts macronutrients, it can be confusing to keep tabs since you aren’t necessarily counting grams of alcohol on a daily basis. Should you count alcohol more like fat (because of the number of calories per oz.) or more like carbs (because of how it’s processed)?

The answer to this question is that you can do either/or. I wouldn’t suggest accounting for it with any grams of protein, but to put this into action, you can take the overall calories for the beverage and account for it with your fats or carbs using their respective caloric density.

For example, let’s just say that you decide to have a glass of wine that has 120 total calories.

• You can account for it with carbohydrates by dividing the total amount of calories (120) by the caloric density (4 calories/gram) to get a total of 30 grams of carbs (120/4).
• You can also account for it with fats by dividing the total amount of calories (120) by the caloric density (9 calories/gram) to get a total of 13 grams of carbs (120/9).
• If you’d like to use some of both, you can decide how many you’d like to use, but here’s an example. Use 60 calories from both carbs and fats, and you get a total of 15 grams of carbohydrates and 7 grams of fat (60/4 and 60/9).

Moderation: Finding a Justified Balance for Something You Enjoy

According to the Dietary Guidelines for Americans, moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men.^[19] This definition refers to the amount consumed on any single day and is not intended as an average over several days.

In addition, the Dietary Guidelines do not recommend that people who do not drink alcohol start drinking for any reason.

I’m surely not in the camp that you need to completely abstain, if drinking alcohol is something that you enjoy and adds value to your life. The key is to find that MODERATION, where drinking adds more value to your life than the compounding of negative consequences that can result in frequent and heavy consumption.

What do I propose moderation might look like in practice?

1. Having 1-2 drinks, 1-2 days/nights per week. Ideally, it would probably be placed on weekends, where you don’t have major responsibilities. For instance, I usually let loose a little bit on Saturday nights and have a drink or two. I don’t have any major commitments outside of church that would be impacted by me having a bit poorer quality sleep.
2. Enjoying your favorite drinks, but make sure that you still are conscious of total energy and alcohol intake. If you aren’t a fan of the lower-calorie drink options, drink what you enjoy. But, it’s not a license to go hog-wild and order numerous drinks with mixers and/or get skunk-faced drunk.
3. Pair it with a lower-calorie meal. On special occasions, when you drink, it will be alongside a three-course dinner or appetizers from the bar. But, if you are going to be drinking liquid calories, you may want to go lighter with your entree or meal of choice.
4. Be Strategic. Like I mentioned in a bullet-point above, while I can be spontaneous, I usually like to be proactive and plan these occasions into my routine. I consider my responsibilities and how I may impact others and really just what the priorities are in my life. You have the decision to say yes or no to any opportunity that falls in line with your higher values of supporting your mental, emotional, social, and physical health.

Practice these guidelines 90% of the time and maybe go over every once in a while.

Conclusion

Overall, I think it is safe to say that alcohol’s impact on our health depends on the amount consumed, drinking frequency, the pattern of consumption, and maybe even the type of alcoholic beverage consumed.

There’s nothing wrong with enjoying a favorite alcoholic beverage, but you have to think about how it fits in the grand scheme of supporting health in all areas of your life.

^[1] World Health Organization. (2019). Global status report on alcohol and health 2018. World Health Organization.

^[2] https://www.precisionnutrition.com/all-about-alcoholic-beverages

^[3] https://www.bodybuilding.com/content/5-ways-alcohol-hinders-fat-loss.html

^[4] https://www.precisionnutrition.com/all-about-alcoholic-beverages

^[5] https://www.precisionnutrition.com/all-about-alcoholic-beverages

^[6] https://www.health.harvard.edu/blog/sorting-out-the-health-effects-of-alcohol-2018080614427#:~:text=Here%20are%20some%20of%20the,pressure%2C%20heart%20failure%2C%20and%20dementia

^[7] Maurel, D. B., Boisseau, N., Benhamou, C. L., & Jaffre, C. (2012). Alcohol and bone: review of dose effects and mechanisms. Osteoporosis International, 23(1), 1-16.

^[8] Eby, J. M., Sharieh, F., & Callaci, J. J. (2020). Impact of Alcohol on Bone Health, Homeostasis, and Fracture Repair. Current Pathobiology Reports, 1-12.

^[9] https://www.precisionnutrition.com/all-about-alcoholic-beverages

^[10] Parr, E. B., Camera, D. M., Areta, J. L., Burke, L. M., Phillips, S. M., Hawley, J. A., & Coffey, V. G. (2014). Alcohol ingestion impairs maximal post-exercise rates of myofibrillar protein synthesis following a single bout of concurrent training. PLoS One, 9(2), e88384.

^[11] Chiva-Blanch, G., & Badimon, L. (2020). Benefits and Risks of Moderate Alcohol Consumption on Cardiovascular Disease: Current Findings and Controversies. Nutrients, 12(1), 108.

^[12] Rimm, E. B., & Moats, C. (2007). Alcohol and coronary heart disease: drinking patterns and mediators of effect. Annals of Epidemiology, 17(5), S3-S7.

^[13] Huang, S., Li, J., Shearer, G. C., Lichtenstein, A. H., Zheng, X., Wu, Y., … & Gao, X. (2017). Longitudinal study of alcohol consumption and HDL concentrations: a community-based study. The American journal of clinical nutrition, 105(4), 905-912.

^[14] Maurel, D. B., Boisseau, N., Benhamou, C. L., & Jaffre, C. (2012). Alcohol and bone: review of dose effects and mechanisms. Osteoporosis International, 23(1), 1-16.

^[15] Gaddini, G. W., Turner, R. T., Grant, K. A., & Iwaniec, U. T. (2016). Alcohol: a simple nutrient with complex actions on bone in the adult skeleton. Alcoholism: clinical and experimental research, 40(4), 657-671.

^[16] https://www.health.harvard.edu/blog/sorting-out-the-health-effects-of-alcohol-2018080614427#:~:text=Here%20are%20some%20of%20the,pressure%2C%20heart%20failure%2C%20and%20dementia

^[17] https://www.bodybuilding.com/content/5-ways-alcohol-hinders-fat-loss.html

^[18] https://www.cnn.com/2018/11/09/health/alcohol-diet-food-drayer/index.html

^[19] https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines